LAKE COUNTY PEDIATRICS SC NPI 1114102530

NPI Information

  • NPI: 1114102530
  • Provider Name: LAKE COUNTY PEDIATRICS SC
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • CLIA Number: 14D0412607
  • Address: 200 S GREENLEAF AVE
    SUITE E
    GURNEE, IL
    ZIP 60031
  • Phone: (847) 336-0770

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NPI Details

LAKE COUNTY PEDIATRICS SC is a pediatrics in Gurnee, IL. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. LAKE COUNTY PEDIATRICS SC NPI is 1114102530. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

200 S GREENLEAF AVE
SUITE E
GURNEE, IL
ZIP 60031
Phone: (847) 336-0770
Fax: (847) 336-0159

The provider's authorized official is Marlene Juco Tanquilut .
The authorized official title is President and has the following contact phone number (847) 336-0770.

The CLIA number assigned to this NPI record is 14D0412607 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/3/2008 and was last updated on 1/3/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsILLINOISYes

What is NPI?

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This page was last updated on: 11/21/2025

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